Physical Examination of Respiratory System

part I


part II

Imaging findings in Bladder Rupture

-Diagnostic evaluation of bladder rupture includes voiding cystourethrography (VCUG) or CT scan

* VCUG
o Voiding cystourethrography historically been preferred contrast enhanced
study for diagnosis of bladder rupture
o Bladder needs to be fully distended and evaluation of a post-voiding
film essential
* Plain film:
o "Pear-shaped" bladder
o Paralytic ileus
o Upward displacement of ileal loops
o Flame-shaped contrast extravasation into perivesical fat
+ Best seen on postvoid films
+ May extend into thigh / anterior abdominal wall

One image from an IVU shows a flame-shaped density adjacent to

right lateral wall of bladder representing extra-peritoneal contrast from a bladder rupture

* US
o "Bladder within a bladder" = bladder surrounded by fluid collection

Is Evidence-Based Medicine a Barrier to Cost-Effective Care?

August 29, 2007 presentation by Alan Garber for the Stanford School of Medicine Medcast lecture series.

Alan Garber, MD, PhD, professor of medicine and the director of the Center for Health Policy and of the Center for Primary Care and Outcomes Research at Stanford University, discusses the importance of distinguishing between a treatment's effectiveness and its value, and in turn what role evidence-based medicine should play in today's coverage decisions.

Lower lobe predominance mnemonic

BADAS

* B: Bronchiectasis
* A: Aspiration pneumonia
* D: Drugs, Desquamative interstitial pneumonia
* A: Asbestosis
* S: Scleroderma and other Collagen vascular diseases

C.I.A.

* C: Collagen vascular disease
* I: Idiopathic pulmonary fibrosis
* A: Asbestosis

Scleroderma

diopathic pulmonary fibrosis

Algorithm for determining the cause of the Hypernatremia

Hypernatremia is defined as a serum sodium > 145 mEq/L

- hypernatremia can be due to:-

* net loss of water and sodium from the body with inadequate water replacement (commonest cause)
* inadequate water intake................

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Disorders of the Parathyroid, Pituitary, and Pancreas: MEN 1

Multiple endocrine neoplasia type 1(MEN 1):It is a relatively uncommon "1 person in every 30,000 people" inherited "autosomal dominant disorder, but it may also occur sporadically as a result of new mutations" disease described by Wermer In 1954 .

Parathyroid tumors

Hyperparathyroidism is the most common manifestation of MEN 1.Clinical manifestations include urolithiasis, bone abnormalities, and, in severe cases, generalized weakness and mental or cognitive dysfunction.
Hyperparathyroidism in MEN 1 differs from sporadic cases by earlier age at presentation, involvement of multiple glands, and high recurrence rate postoperatively (50% by 8-12 y after surgery).

Enteropancreatic tumors

Pancreatic islet cell tumors represent the second most common manifestation of MEN 1 and occur in 80% of patients.
Nonfunctioning pancreatic endocrine tumors are the most common pancreatic tumors, occurring in 80-100% of cases
Gastrinomas are the most common cause of symptomatic disease and are found in approximately 60% of patients with MEN 1. Compared with the sporadic form of gastrinomas in Zollinger-Ellison syndrome (ZES), tumors in MEN 1 are more often duodenal, small, and multicentric, thus diminishing the probability of surgical cure. The features predictive of poor prognosis include pancreatic location of lesions, metastases, ectopic Cushing syndrome, and height of gastrin levels. Development of gastrinomas is preceded by multifocal hyperplasia of the gastrin-producing cells. Long-standing MEN 1/ZES may lead to development of gastric carcinoid tumors that might be aggressive.
Insulinomas account for approximately 20-35% of functional pancreatic islet cell tumors. Similar to gastrinomas, they can be multicentric (10-20%), where 25% metastasize either to regional lymph nodes or to the liver.
Glucagonomas occur in 3% of patients with MEN 1 and are silent or present with hyperglycemia. Only a few patients show the typical skin lesions known as necrolytic migratory erythema.

The occurrence of the watery diarrhea, hypokalemia, hypochlorhydria, and acidosis (WDHA) syndrome (incidence approximately 1%) may be due either to either a pancreatic islet cell or to a carcinoid tumor.

Pituitary tumors

These often-multicentric tumors occur in more than 50% of patients and are clinically apparent in up to 20% of patients. These tumors tend to be larger and more aggressive than those not associated with MEN 1.

Prolactinomas are the most common pituitary tumor in patients with MEN 1.

Growth hormone–producing tumors account for 25% of these adenomas. Growth hormone levels rise due to autonomous secretion from the pituitary tumor or, less commonly, by production of growth hormone–releasing factor by a pancreatic or other endocrine tumor.

A pituitary tumor or carcinoid tumor that produces corticotropin can cause Cushing syndrome in patients with MEN 1. Ectopic production of corticotropin-releasing factor from a pancreatic islet cell tumor also has been described.

To read a case of MEN 1 : Click Here

Neuroscience at a Glance

This third edition of one of the most popular titles in the at a Glance series contains essential integrated information on anatomy, biochemistry, physiology and pharmacology to provide a review of the structure and function of the nervous system. Neuroscience at a Glance is the perfect introduction and revision aid to this notoriously difficult subject area and features:

* New chapters on consciousness, memory, emotion and drug addiction, and imaging the nervous system
* Highly visual presentation with full-colour illustrations and the inclusion of high-quality CT and other neurological scans
* Self-assessment case studies to make revision more rewarding
* A companion website at www.medicalneuroscience.com with self-assessment, case studies, a glossary, further reading and other useful information.

Neuroscience at a Glance will appeal to medical students, biomedical science students and junior doctors. In addition, the text is a suitable companion for nurses and other students of allied health

GET IT

Antrochoanal Polyp

Antrochoanal polyps, are solitary polyps arising from the maxillary antrum. They were first described by Killian in 1906. Although their etiology remains unknown, allergy has been implicated........

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Endoscopic photograph of right nasal cavity showing an antrochoanal polyp arising from the middle meatus and blocking the right posterior choana.

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Diabetes-Related Atherosclerosis